Abstract:
OBJECTIVE:To examine the relationship between an obstetrician's delivery volume and a patient's risk for cesarean delivery. METHODS:This retrospective cohort study examined patient-level and obstetrician-level data between 2000 and 2012 at a large academic hospital. All laboring patients who delivered viable, liveborn, singleton newborns (N=58,328) were included. We measured the association of delivery volume and cesarean delivery using a multivariate logistic regression. We also assessed the association of volume by calculating adjusted cesarean delivery rates using the least squares means method. These analyses were performed on the subset of nulliparous patients with term, singleton, vertex-presenting fetuses. In addition, the association of obstetrician experience was compared against delivery volume. RESULTS:There was a twofold increase in the odds of cesarean delivery for patients whose obstetricians performed fewer than the median (60) number of deliveries per year (quartile 1: odds ratio 2.00, 95% confidence interval 1.68-2.38; quartile 2: odds ratio 2.73, 95% CI 2.40-3.11) as compared with quartile 4. The adjusted cesarean delivery rate decreased from 18.2% to 9.2% from the highest to lowest volume quartile (P<.001). Compared with the volume effects, an obstetrician's experience had a smaller effect on a patient's risk of cesarean delivery. CONCLUSION:Patients delivered by obstetricians with low delivery volume are at significantly increased risk for cesarean delivery after controlling for patient and obstetrician characteristics. In contrast, obstetrician experience had a less significant effect. These findings may prompt discussions regarding the role of volume in credentialing and practice models that direct patients to obstetricians with high delivery volume. LEVEL OF EVIDENCE:: II.
journal_name
Obstet Gynecoljournal_title
Obstetrics and gynecologyauthors
Clapp MA,Melamed A,Robinson JN,Shah N,Little SEdoi
10.1097/AOG.0000000000000473subject
Has Abstractpub_date
2014-10-01 00:00:00pages
697-703issue
4eissn
0029-7844issn
1873-233Xpii
00006250-201410000-00008journal_volume
124pub_type
杂志文章abstract:OBJECTIVE:To estimate the association between vaginal birth after cesarean delivery (VBAC) rates and primary cesarean delivery rates in California hospitals. METHODS:Hospital VBAC rates were calculated using birth certificate and discharge data from 2009, and hospitals were categorized by quartile of VBAC rate. Multiv...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0b013e3182a91e0f
更新日期:2013-11-01 00:00:00
abstract:INTRODUCTION:The first transdermal drug delivery system was introduced in the United States over 20 years ago. Created as an alternative route of administration to improve patient compliance as well as to reduce side effects, the transdermal delivery of drugs now represents a $1.5 to $2 billion market and is growing ra...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/01.AOG.0000161958.70059.db
更新日期:2005-05-01 00:00:00
abstract:OBJECTIVE:To review the experience of women who conceived after developing mastocytosis and who were observed at the National Institutes of Health. METHODS:We reviewed our patient database for the years 1984-1998 to identify women with mastocytosis who had conceived. We then reviewed each woman's record, asked each wo...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0029-7844(99)00591-8
更新日期:2000-03-01 00:00:00
abstract:OBJECTIVE:To explore the pregnancy and childbirth experiences and preferences of women with a history of sexual trauma in order to identify trauma-informed care practices that health care providers may use to improve obstetric care. METHODS:We conducted a qualitative study consisting of semistructured interviews with ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0000000000002956
更新日期:2018-12-01 00:00:00
abstract::Female sexual dysfunction (FSD) is characterized as chronic sexual symptoms that manifest with personal distress in the domains of desire, arousal, orgasm, and pain. Extensive epidemiologic evidence estimates that almost 50% of perimenopausal and postmenopausal women experience FSD. Screening for FSD is not readily co...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0000000000002268
更新日期:2017-10-01 00:00:00
abstract::A rapid, simple method for screening individuals at high risk for the presence of Y chromosomes is described. The correlation with actual sex using probability tables from Baye's formula have shown to be accurate, when used with a 99% confidence limit. This procedure can be utilized in the investigation of amenorrhea ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1976-12-01 00:00:00
abstract::Evidence-based medicine, the new practice paradigm, is rapidly replacing medicine by authority, the traditional paradigm. In 1993, we introduced evidence-based practice into our Department of Obstetrics, Gynecology, and Reproductive Sciences at San Francisco General Hospital, University of California, San Francisco. W...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0029-7844(95)00184-S
更新日期:1995-09-01 00:00:00
abstract::Prenatal lead exposure has known adverse effects on maternal health and infant outcomes across a wide range of maternal blood lead levels. Adverse effects of lead exposure are being identified at lower levels of exposure than previously recognized in both children and adults. In 2010, the Centers for Disease Control a...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0b013e31826804e8
更新日期:2012-08-01 00:00:00
abstract:BACKGROUND:Cortical blindness is a complication of severe preeclampsia, but it is unclear whether it results from cerebral vasospasm and ischemic injury or vasogenic (hydrostatic) edema due to increased capillary permeability. CASE:Reversible cortical blindness in a 33-year-old gravida 2, para 1, with severe postpartu...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0029-7844(00)00878-4
更新日期:2000-06-01 00:00:00
abstract::This report studies the Resource Mothers Program, an organization that improves perinatal outcome through social support. Resource Mothers are nonprofessional women who combine warmth, parenting experience, and knowledge of their local community services to reduce the hazards associated with rural adolescent pregnancy...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1987-08-01 00:00:00
abstract::Checklists are used in medical and nonmedical settings as cognitive aids to ensure that users complete all the items associated with a particular task. They are ideal for tasks with many steps, for tasks performed under stressful circumstances, or for reminding people to perform tasks that they are not routinely accus...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0000000000001766
更新日期:2016-11-01 00:00:00
abstract::Pregnancy complicated by ovarian endometrioma is rare; only four cases have been reported. Although infertility and endometriosis are closely related, endometriosis may be found with pregnancy and, although it has been written that endometriosis will regress with pregnancy, occasionally complications may occur. This r...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1983-10-01 00:00:00
abstract:OBJECTIVE:To evaluate sonographic measurements of endometrial thickness in postmenopausal women taking adjuvant tamoxifen therapy for breast cancer, and to correlate sonographic and pathologic findings to symptoms and duration of tamoxifen therapy. METHODS:Medical records and sonograms of 80 postmenopausal women treat...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0029-7844(98)00418-9
更新日期:1999-03-01 00:00:00
abstract:OBJECTIVE:To compare a "no touch" approach to diagnostic hysteroscopy without anesthesia with traditional diagnostic hysteroscopy after intracervical injection of mepivacaine hydrochloride 3%. METHODS:A total of 130 women undergoing diagnostic hysteroscopy were included in the study and were randomized, using a comput...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,随机对照试验
doi:10.1097/01.AOG.0000227750.93984.06
更新日期:2006-08-01 00:00:00
abstract:OBJECTIVE:To evaluate the association of sociodemographic and hospital characteristics with adherence to National Comprehensive Cancer Network treatment guidelines for stage IB-IIA cervical cancer and to analyze the relationship between adherent care and survival. METHODS:This is a retrospective population-based cohor...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0000000000002591
更新日期:2018-05-01 00:00:00
abstract::Despite earlier studies, there remain unanswered questions regarding urinary calculi in pregnancy. The authors studied 11 cases in 11,292 deliveries over 5 years. Eight previous studies were also studied and data were compiled from 96 cases in 138,296 patients. The incidence of urinary calculi in pregnancy is approxim...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1980-10-01 00:00:00
abstract::Two hundred ten rats were randomized into one of five study groups to compare standard absorbable sutures with a new synthetic absorbable suture. We evaluated Maxon (polyglyconate), Vicryl (polyglactin), chromic catgut (catgut), and PDS (polydioxanone) with respect to tissue inflammatory reaction, knot security, sutur...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1988-03-01 00:00:00
abstract::A patient with non-mosaic Turner syndrome and normal fertility had four documented pregnancies, two of which were carried to term. Although her fertility history can be considered normal, she did not have spontaneous sexual maturation or menarche, and bilateral streak gonads were identified on laparotomy for tubal lig...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1985-03-01 00:00:00
abstract:OBJECTIVE:To determine whether the diagnosis of cervical intraepithelial neoplasia (CIN) grade 1 increases the risk of CIN 3 above what is observed for human papillomavirus (HPV) infection. METHODS:Using data from the atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial l...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,多中心研究
doi:10.1097/AOG.0b013e318237caf4
更新日期:2011-12-01 00:00:00
abstract:OBJECTIVE:To determine whether glucagon has relaxant effects on the spontaneous contractions of term pregnant human uterine smooth muscle in an isolated preparation. METHODS:Myometrial specimens were excised from the upper incisional surface of the lower uterine segment in seven women during elective cesarean delivery...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0029-7844(96)00283-9
更新日期:1996-11-01 00:00:00
abstract:BACKGROUND:Endometrial stromal nodule is a rare subtype of endometrial stromal tumor. Although such nodules are benign, hysterectomy has been considered the treatment of choice, because evaluation of the margin is required for diagnosis. The similarity between low-grade stromal sarcoma and stromal nodule suggests that ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0029-7844(98)00332-9
更新日期:1999-05-01 00:00:00
abstract::A simple, rapid, sensitive, and reliable ELISA test for the detection of urinary human chorionic gonadotropin (hCG) has been developed using penicillinase (EC no. 3.5.2.6) as the label and a microtiter ELISA plate as a solid support for antibody. The results of the test is assessed visually for the dark blue that indi...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1981-02-01 00:00:00
abstract::Danazol is a synthetic steroid with antigonadotropic properties useful in treating endometriosis, especially in young infertile women. Prior to its availability for clinical use in September 1976, thyroid function studies other than thyroid-stimulating hormone (TSH), which was normal, had not been reported. Soon after...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/00006250-198003000-00028
更新日期:1980-03-01 00:00:00
abstract::Patient choices and plans may sometimes carry increased risk or include alternatives that individual physicians feel uncomfortable supporting or recommending. We consider in this commentary how the ethical principles of respect for autonomy and nonmaleficence can be balanced using, among other examples, the choice by ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0b013e3182167413
更新日期:2011-05-01 00:00:00
abstract:OBJECTIVE:Increasing use of fertility drugs is considered the primary cause for the recent increase in dizygotic twinning in developed countries. However, dizygotic twinning has also been related to obesity in foreign populations. We sought to confirm this relationship in U.S. pregnancies, which predated widespread use...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/01.AOG.0000153491.09525.dd
更新日期:2005-03-01 00:00:00
abstract::Thirty-six patients with menorrhagia were treated with a technique for laser destruction of the endometrium in which the end of the fiberoptic guide of the Nd:Yag laser is not allowed to come in contact with the endometrium. The results were excellent in 93.9% of the 33 patients followed over three months. Amenorrhea ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1987-04-01 00:00:00
abstract::The authors report on the incidence of translocations detected among 300 Greek couples referred for cytogenetic investigation because of repeated abortion, stillbirth, and/or the birth of children with multiple congenital anomalies. Translocations were detected in 16 cases, ie, 1 of 19 couples. However, the incidence ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1981-10-01 00:00:00
abstract::An unusual myxoid and vascular appearing neoplasm of the vulva, termed an aggressive angiomyxoma, is described in a 36-year-old Hispanic woman. The clinical presentation and recurrence pattern were typical for previously described neoplasms of the same cellular pattern. The histopathology, difficulties in determining ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1986-09-01 00:00:00
abstract:OBJECTIVE:To estimate the frequency of mismatch repair deficiencies associated with hereditary nonpolyposis colorectal cancer, or Lynch syndrome, in women less than age 50 with endometrial cancer. METHODS:Consecutive patients less than age 50 diagnosed with endometrial adenocarcinoma were identified. Available patholo...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0b013e31817051d9
更新日期:2008-05-01 00:00:00
abstract:OBJECTIVE:To examine associations between pregnancy weight gain outside and within ranges recommended by the Institute of Medicine and birth weight by both prepregnant body mass index (BMI) and race-ethnicity. METHODS:Mean birth weight and incidence of term low birth weight (LBW, less than 2500 g) and high birth weigh...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0029-7844(98)00106-9
更新日期:1998-06-01 00:00:00